William A. Mattingly

Adults Hospitalized With Pneumonia in the United States: Incidence, Epidemiology, and Mortality

Background Understanding the burden of community-acquired pneumonia (CAP) is critical to allocate resources for prevention, management, and research. The objectives of this study were to define incidence, epidemiology, and mortality of adult patients hospitalized with CAP in the city of Louisville, and to estimate burden of CAP in the US adult population. Methods This was a prospective population-based cohort study of adult residents in Louisville, Kentucky, from 1 June 2014 to 31 May 2016. Consecutive hospitalized patients with CAP were enrolled at all adult hospitals in Louisville. The annual population-based CAP incidence was calculated. Geospatial epidemiology was used to define ecological associations among CAP and income level, race, and age. Mortality was evaluated during hospitalization and at 30 days, 6 months, and 1 year after hospitalization. Results During the 2-year study, from a Louisville population of 587499 adults, 186384 hospitalizations occurred. A total of 7449 unique patients hospitalized with CAP were documented. The annual age-adjusted incidence was 649 patients hospitalized with CAP per 100000 adults (95% confidence interval, 628.2-669.8), corresponding to 1591825 annual adult CAP hospitalizations in the United States. Clusters of CAP cases were found in areas with low-income and black/African American populations. Mortality during hospitalization was 6.5%, corresponding to 102821 annual deaths in the United States. Mortality at 30 days, 6 months, and 1 year was 13.0%, 23.4%, and 30.6%, respectively. Conclusions The estimated US burden of CAP is substantial, with >1.5 million unique adults being hospitalized annually, 100000 deaths occurring during hospitalization, and approximately 1 of 3 patients hospitalized with CAP dying within 1 year.

Robot design using Unity for computer games and robotic simulations

We present a new approach to robot design, using the Unity development environment as the primary authoring tool for a functional virtual robot. We also discuss the development of a collection of design assets in the form of Unity packages which we have found to greatly improve the workflow and accessibility of robot design for computer games and robotic simulations.

The order of administration of macrolides and beta-lactams may impact the outcomes of hospitalized patients with community-acquired pneumonia: results from the community-acquired pneumonia organization

Abstract Background: The beneficial effect of macrolides for the treatment of community-acquired pneumonia (CAP) in combination with beta-lactams may be due to their anti-inflammatory activity. In patients with pneumococcal meningitis, the use of steroids improves outcomes only if they are administered before beta-lactams. The objective of this study was to compare outcomes in hospitalized patients with CAP when macrolides were administered before, simultaneously with, or after beta-lactams. Methods: Secondary data analysis of the Community-Acquired Pneumonia Organization (CAPO) International Cohort Study database. Study groups were defined based on the sequence of administration of macrolides and beta-lactams. The study outcomes were time to clinical stability (TCS), length of stay (LOS) and in-hospital mortality. Accelerated failure time models were used to evaluate the adjusted impact of sequential antibiotic administration and time-to-event outcomes, while a logistic regression model was used to evaluate their adjusted impact on mortality. Results: A total of 99 patients were included in the macrolide before group and 305 in the macrolide after group. Administration of a macrolide before a beta-lactam compared to after a beta-lactam reduced TCS (3 vs. 4 days, p = .011), LOS (6 vs. 7 days, p = .002) and mortality (3 vs. 7.2%, p = .228). Conclusions: The administration of macrolides before beta-lactams was associated with a statistically significant decrease in TCS and LOS and a non-statistically significant decrease in mortality. The beneficial effect of macrolides in hospitalized patient with CAP may occur only if administered before beta-lactams.

Infection prevention and control and the refugee population: Experiences from the University of Louisville Global Health Center

Background: During 2016, approximately 140,000 individuals entered the United States as part of the federal government refugee resettlement program and established themselves in communities in virtually every state. No national database regarding refugee health currently exists; therefore, little is known about existing infectious diseases, conditions, and cultural practices that impact successful acculturation. The objective of this report is to identify what is currently known about refugees and circumstances important to infection prevention and control with respect to their roles as new community members, employees, and consumers of health care. Methods: Using data from the University of Louisville Global Health Centers Newly Arriving Refugee Surveillance System, health issues affecting refugees from the perspective of a community member, an employee, and a patient were explored. Results: Lack of immunity to vaccine‐preventable diseases is the most widespread issue impacting almost every adult, adolescent, and child refugee resettled in Kentucky. Health issues of concern from an infection prevention and control perspective include latent tuberculosis infection, HIV, hepatitis B, hepatitis C, syphilis, and parasites. Other health conditions that may also be important include anemia, obesity, oral health, diabetes, and cardiovascular disease. Conclusions: Refugee resettlement provides motivation for collaborative work among those responsible for infection prevention and control in all settings, their public health partners, and those responsible for and interested in community workforce concerns.

Effectiveness of 13-Valent Pneumococcal Conjugate Vaccine Against Hospitalization for Community-Acquired Pneumonia in Older US Adults: A Test-Negative Design

Our study demonstrated real-world, direct effectiveness of 13-valent pneumococcal conjugate vaccine against vaccine-type community-acquired pneumonia following introduction into a routine immunization program among adults aged ≥65 years, many of whom had immunocompromising and chronic medical conditions.

3D modeling of branching structures for anatomical instruction

Branching tubular structures are prevalent in many different organic and synthetic settings. From trees and vegetation in nature, to vascular structures throughout human and animal biology, these structures are always candidates for new methods of graphical and visual expression. We present a modeling tool for the creation and interactive modification of these structures. Parameters such as thickness and position of branching structures can be modified, while geometric constraints ensure that the resulting mesh will have an accurate anatomical structure by not having inconsistent geometry. We apply this method to the creation of accurate representations of the different types of retinal cells in the human eye. This method allows a user to quickly produce anatomically accurate structures with low polygon counts that are suitable for rendering at interactive rates on commodity computers and mobile devices.

Real-time enrollment dashboard for multisite clinical trials

Objective Achieving patient recruitment goals is critical for the successful completion of a clinical trial. We designed and developed a web-based dashboard for assisting in the management of clinical trial screening and enrollment. Materials and methods We use the dashboard to assist in the management of two observational studies of community-acquired pneumonia. Clinical research associates and managers using the dashboard were surveyed to determine its effectiveness as compared with traditional direct communication. Results The dashboard has been in use since it was first introduced in May of 2014. Of the 23 staff responding to the survey, 77% felt that it was easier or much easier to use the dashboard for communication than to use direct communication. Conclusion We have designed and implemented a visualization dashboard for managing multi-site clinical trial enrollment in two community acquired pneumonia studies. Information dashboards are useful for clinical trial management. They can be used in a standalone trial or can be included into a larger management system.

Efficacy of a novel skin antiseptic against carbapenem-resistant Enterobacteriaceae

Infections caused by carbapenem-resistant Enterobacteriaceae (CRE) are increasing on a global scale. Because of the need for CRE transmission prevention and control, we sought to evaluate the efficacy of a silver-based skin antiseptic against these organisms. Using a human skin analog, a third party laboratory conducted efficacy testing. The results suggest that this product provides antimicrobial activity against CRE on human skin. Because of the unique properties, this antiseptic may be useful for daily bathing of hospitalized patients to assist in the control of CRE.

Macrolide therapy is associated with lower mortality in community-acquired bacteraemic pneumonia

BACKGROUND Community-acquired pneumonia (CAP) has a potential complication of bacteremia. The objective of this study was to define the clinical outcomes of patients with CAP and bacteremia treated with and without a macrolide. MATERIALS AND METHODS Secondary analysis of the Community-Acquired Pneumonia Organization database of hospitalized patients with CAP. Patients with a positive blood culture were categorized based on the presence or absence of a macrolide in their initial antimicrobial regimen, and severity of their CAP. Outcomes included in-hospital all-cause mortality, 30-day mortality, length of stay, and time to clinical stability. RESULTS Among 549 patients with CAP and bacteremia, 247 (45%) were treated with a macrolide and 302 (55%) were not. The primary pathogen was Streptococcus pneumoniae (74%). Poisson regression with robust error variance models were used to compare the adjusted effects of each study group on the outcomes. The unadjusted 30-day mortality was 18.4% in the macrolide group, and 29.6% in the non-macrolide group (adjusted relative risk (aRR)0.81; 95% confidence interval (CI)0.50-1.33; P = 0.41). Unadjusted in-hospital all-cause mortality was 7.3% in the macrolide group, and 18.9% in the non-macrolide group (aRR 0.54, 95% CI 0.30-0.98; P = 0.043). Length of stay and time to clinical stability were not significantly different. CONCLUSIONS In-hospital mortality, but not 30-day mortality, was significantly better in the macrolide group. Our data support the use of a macrolide in hospitalized patients with CAP and bacteraemia.

Methods for computational disease surveillance in infection prevention and control: Statistical process control versus Twitter's anomaly and breakout detection algorithms

HighlightsWe compared traditional Statistical Process Control (SPC) charts with novel Anomaly/Breakout Detection (ABD) charts using Twitters Anomaly and Breakout detection algorithms for detecting out of control or anomalous HAI data.ABD charts appeared to work better than SPC charts in the context of seasonality and autocorrelation, two well‐known statistical issues with HAI data.These new charts may be useful for trending of HAI data and for other quality improvement data monitoring.An open‐access web application is provided for users to apply their own datasets to generate ABD and SPC charts. Background: Although not all health care‐associated infections (HAIs) are preventable, reducing HAIs through targeted intervention is key to a successful infection prevention program. To identify areas in need of targeted intervention, robust statistical methods must be used when analyzing surveillance data. The objective of this study was to compare and contrast statistical process control (SPC) charts with Twitters anomaly and breakout detection algorithms. Methods: SPC and anomaly/breakout detection (ABD) charts were created for vancomycin‐resistant Enterococcus, Acinetobacter baumannii, catheter‐associated urinary tract infection, and central line‐associated bloodstream infection data. Results: Both SPC and ABD charts detected similar data points as anomalous/out of control on most charts. The vancomycin‐resistant Enterococcus ABD chart detected an extra anomalous point that appeared to be higher than the same time period in prior years. Using a small subset of the central line‐associated bloodstream infection data, the ABD chart was able to detect anomalies where the SPC chart was not. Discussion: SPC charts and ABD charts both performed well, although ABD charts appeared to work better in the context of seasonal variation and autocorrelation. Conclusions: Because they account for common statistical issues in HAI data, ABD charts may be useful for practitioners for analysis of HAI surveillance data.